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The use of self-expanding silicone stents in esophageal cancer care: optimal pre-, peri-, and postoperative care

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Abstract

Background

Preoperative nutritional supplementation, management of esophageal leaks, and postoperative anastomotic strictures still remain common problems in the management of esophageal cancer. Jejunal feeding tubes, total parenteral nutrition (TPN) with nasogastric suction, and repeated esophageal dilations remain the most common treatments, respectively. The aim of this study was to evaluate the use of removable silicone stents in (1) the preoperative nutritional optimization during neoadjuvant therapy, (2) the management of perioperative anastomotic leak, and (3) the management of postoperative anastomotic strictures.

Methods

Review of our prospectively maintained esophageal database identified 15 patients who had removable self-expanding silicone stents placed in the management of one of these three management problems from July 2004 to August 2006.

Results

Preoperative therapy: Five patients underwent initial stent placement in preparation for neoadjuvant therapy. Dysphagia relief was seen in 100% of patients, with optimal caloric needs taken within 24 h of placement. All patients tolerated neoadjuvant therapy without delay from dehydration or malnutrition. One stent migration was found at the time of operation, which was removed without sequelae. Perioperative therapy: Five patients developed delayed (>10 days) esophageal leaks that were managed with removable esophageal stent and percutaneous drainage (in three patients). All patients had successful exclusion of the leak on the day of the procedure with resumption of oral intake on the evening of procedure. All five healed leaks without sequelae. Postoperative therapy: Five patients developed postoperative anastomotic strictures that required dilation and placement of removable esophageal stent. The median number of dilations was 1 (range 1–2), with all stents placed for approximate 3 months duration. All patients had immediate dysphagia relief after stent placement.

Conclusion

Removable esophageal stents are novel treatment option to optimize relief of symptoms and return the patients back to a more normal oral intake. Continued evaluation is needed to consider stent use as first-line therapy.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine, 315 East Broadway – Rm 313, Louisville, KY, 40202, USA

    Robert Martin, Ryan Duvall, Susan Ellis & Charles R. Scoggins

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  1. Robert Martin
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  2. Ryan Duvall
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  3. Susan Ellis
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  4. Charles R. Scoggins
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Correspondence to Robert Martin.

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Martin, R., Duvall, R., Ellis, S. et al. The use of self-expanding silicone stents in esophageal cancer care: optimal pre-, peri-, and postoperative care. Surg Endosc 23, 615–621 (2009). https://doi.org/10.1007/s00464-008-9851-x

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  • DOI: https://doi.org/10.1007/s00464-008-9851-x

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